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Protocol for a randomised trial of higher versus lower intensity patient-provider communication interventions to reduce antibiotic misuse in two paediatric ambulatory clinics in the USA
- Source :
- BMJ Open
- Publication Year :
- 2018
- Publisher :
- BMJ Publishing Group, 2018.
-
Abstract
- IntroductionChildren with acute respiratory tract infections (ARTIs) are prescribed up to 11.4 million unnecessary antibiotic prescriptions annually. Inadequate parent–provider communication is a chief contributor, yet efforts to reduce overprescribing have only indirectly targeted communication or been impractical. This paper describes our multisite, parallel group, cluster randomised trial comparing two feasible interventions for enhancing parent–provider communication on the rate of inappropriate antibiotic prescribing (primary outcome) and revisits, adverse drug reactions and parent-rated quality of shared decision-making, parent–provider communication and visit satisfaction (secondary outcomes).Methods/analysisWe will attempt to recruit all eligible paediatricians and nurse practitioners (currently 47) at an academic children’s hospital and a private practice. Using a 1:1 randomisation, providers will be assigned to a higher intensity education and communication skills or lower intensity education-only intervention and trained accordingly. We will recruit 1600 eligible parent–child dyads. Parents of children ages 1–5 years who present with ARTI symptoms will be managed by providers trained in either the higher or lower intensity intervention. Before their consultation, all parents will complete a baseline survey and view a 90 s gain-framed antibiotic educational video. Parent–child dyads consulting with providers trained in the higher intensity intervention will, in addition, receive a gain-framed antibiotic educational brochure promoting cautious use of antibiotics and rate their interest in receiving an antibiotic which will be shared with their provider before the visit. All parents will complete a postconsultation survey and a 2-week follow-up phone survey. Due to the two-stage nested design (parents nested within providers and clinics), we will employ generalised linear mixed-effect regression models.Ethics/disseminationEthical approval was obtained from the Children’s Mercy Hospital Pediatric Institutional Review Board (#16060466). Results will be submitted for publication in peer-reviewed journals.Trial registration numberNCT03037112; Pre-results.
- Subjects :
- Male
Research design
medicine.medical_specialty
education
Psychological intervention
Inappropriate Prescribing
Ambulatory Care Facilities
quality in health care
paediatrics
primary care
03 medical and health sciences
Patient safety
0302 clinical medicine
Clinical Protocols
030225 pediatrics
Protocol
Humans
Medicine
030212 general & internal medicine
Practice Patterns, Physicians'
Medical prescription
Respiratory Tract Infections
Randomized Controlled Trials as Topic
Primary Health Care
business.industry
Communication
public health
Infant
General Medicine
Institutional review board
Antibiotic misuse
Anti-Bacterial Agents
Health Communication
Communication Intervention
Research Design
Private practice
Child, Preschool
Family medicine
Female
business
Subjects
Details
- Language :
- English
- ISSN :
- 16060466
- Database :
- OpenAIRE
- Journal :
- BMJ Open
- Accession number :
- edsair.doi.dedup.....0334d0db1eb47b27e7ab5c34c32baac4